Individual
MICHAEL R ABIDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6355 WALKER LANE, SUITE 308, ALEXANDRIA, VA 22310-3247
(703) 313-7700
(703) 313-0178
Mailing address
224D CORNWALL ST NW STE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(571) 291-9786
Taxonomy
Speciality
Code
Description
License number
State
207YX0602X
Otolaryngic Allergy Physician
0101054696
VA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
0101054696
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568465912
—
VA
05
—
30016181230001
—
VA
01
—
P00711443
RR MEDICARE
DC
Enumeration date
05/31/2005
Last updated
10/09/2023
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